The latest medical research on Immunology & Allergy

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about immunology & allergy gathered by our medical AI research bot.

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The Role of Heat Shock Protein 70 kDa in Asthma.

Journal of Asthma and Allergy

Asthma is a complex chronic disorder of the airways, affecting immune and structural cells and inducing both protein and tissue remodeling. Heat sh...

Using longitudinal genetic-network study to understand HIV treatment-as-prevention: a population-based observational study.

AIDS

The World Health Organization (WHO) has recommended that antiretroviral therapy be provided to all HIV patients to reduce future HIV transmission rates. However, few studies have examined this public health strategy at the population level in a real-world setting.

In this longitudinal genetic-network study in Guangxi, China, the baseline and follow-up data were collected from HIV patients in 2014 and newly diagnosed HIV patients from 2015 to 2018, respectively. The prevention efficacy (PE) was used to estimate the effect of treatment-as-prevention in reducing HIV secondary transmission.

Among 804 newly diagnosed HIV patients during 2015-2018, 399 (49.6%) of them genetically linked to HIV patients at baseline during 2014-2017. The overall proportion of genetic linkage between newly diagnosed HIV patients during 2015-2018 with untreated and treated HIV patients at baseline during 2014-2017 was 6.2% and 2.9%, respectively. The PE in HIV transmission for treated HIV patients was 53.6% (95% CI: 42.1%-65.1%). Subgroup analyses indicated an 80.3% (95% CI: 74.8%-85.8%) reduction in HIV transmission among HIV patients who were treated for 4 years or more and had viral loads <50 copies/ml. There was no significant reduction in HIV transmission among treated HIV patients who dropped out or who had missing viral load measures.

Our study results support the feasibility of treating all HIV patients for future reductions in HIV transmission at the population level in real-world settings. Comprehensive intervention prevention programs are urgently needed.

Incidence of dyslipidemia in people with HIV who are treated with integrase inhibitors versus other antiretroviral agents.

AIDS

To compare the incidence of dyslipidemia in people with HIV (PLWH) receiving integrase inhibitors (INSTI) versus boosted protease inhibitors (PI/b) and non-nucleoside reverse transcriptase inhibitors (NNRTI) within RESPOND consortium of prospective cohorts.

Participants were eligible if they were ≥18 years, without dyslipidemia and initiated or switched to a three-drug ART-regimen consisting of either INSTI, NNRTI or PI/b for the first time, between 01/01/2012 and 31/12/2018. Dyslipidemia was defined as random total cholesterol >240 mg/dL, high-density lipoprotein < 35 mg/dL, triglyceride >200 mg/dL, or initiation of lipid-lowering therapy. Poisson regression was used to determine the adjusted incidence rate ratios (aIRR). Follow-up was censored after three years or upon ART-regimen discontinuation or last lipid measurement or 31/12/2019, whichever occurred first.

Overall, 4577 PLWH were eligible (INSTI = 66.9%, PI/b = 12.5%, and NNRT = 20.6%), 1938 (42.3%) of whom were ART-naive. During 1.7 (interquartile range, 0.6-3.0) median years of follow-up, 1460 participants developed dyslipidemia (incidence rate: 191.6 per 1000 person-years, 95% confidence interval [CI] 182.0-201.7). Participants taking INSTI had a lower incidence of dyslipidemia compared to those on PI/b (aIRR 0.71; CI 0.59-0.85), but higher rate compared to those on NNRTI (1.35; CI 1.15-1.58). Compared to dolutegravir, the incidence of dyslipidemia was higher with elvitegravir/cobicistat (1.20; CI 1.00-1.43) and raltegravir (1.24; CI 1.02-1.51), but lower with rilpivirine (0.77; CI 0.63-0.94).

In this large consortium of heterogeneous cohorts, dyslipidemia was less common with INSTI than with PI/b. Compared to dolutegravir, dyslipidemia was more common with elvitegravir/cobicistat and raltegravir, but less common with rilpivirine.

Revisiting Late-Onset Asthma: Clinical Characteristics and Association with Allergy.

Journal of Asthma and Allergy

The Global Initiative for Asthma (GINA) 2020 defines late-onset asthma (LOA) as one of the clinical phenotypes of asthma wherein patients, particul...

Got a Pen for Allergen Immunotherapy? Lessons from Near-Fatal Anaphylaxis with Pulmonary Edema.

Journal of Asthma and Allergy

On our pediatric intensive care unit, we successfully treated a 10-year-old boy with severe pulmonary edema due to anaphylaxis after his last injec...

Approach to Perioperative Anaphylaxis in 2020: Updates in Diagnosis and Management.

Current Allergy and Asthma Reports

The goal of the paper is to review the epidemiology, pathogenesis, diagnosis, and manifestations of perioperative anaphylaxis (POA). We seek to review the most common culprits of POA and different diagnostic modalities for evaluation.

Specific IgE testing has a limited role in POA evaluation due to lack of widespread availability and low sensitivity. Basophil activation testing is complementary to skin tests and can assist NMBA sensitivity diagnosis in complex cases. In the past years, there has been an exponential increase in suspected teicoplanin allergic reactions in the European Union. Chlorhexidine is also being increasingly implicated as a culprit in POA. Multiple classes of perioperative medications cause POA. Diagnostic modalities available include skin testing with nonirritating concentrations, basophil activation tests, specific IgE, and drug provocation testing. An accurate record and critical analysis of perioperative events is more important than isolated test results. Future studies evaluating the pathophysiology of these reactions and other therapeutic strategies, such as targeting the MRGPRX2 receptor, are needed.

Cleaning Agent Usage in Healthcare Professionals and Relationship to: Lung and Skin Symptoms.

J Asthma

Healthcare workers have an increased risk of respiratory symptoms and dermatitis, likely related to cleaning/disinfecting agents. The aim of this study was to identify work tasks and cleaning/disinfecting agents associated with respiratory symptoms and hand dermatitis among healthcare workers in a tertiary hospital.

Cleaning agent usage, respiratory symptoms and skin symptoms were recorded by participants using a questionnaire in a cross-sectional study. Age and sex adjusted odds ratios (OR) were used to examine associations between job tasks, exposures, respiratory and skin outcomes.

Two hundred and thirty healthcare workers who were exposed to cleaning agents were compared with 77 who had no, or minimal, exposure. Exposed workers had an increased risk of respiratory symptoms (adjusted OR =1.17, 95% CI: 1.18-4.14) and skin symptoms (adjusted OR =1.77, 95% CI: 1.00 - 3.17) versus. Washing instruments manually, using aerosol products, cleaning operating rooms, cleaning sanitary rooms, preparing disinfectants and filling devices with cleaning products were cleaning tasks associated with various respiratory symptoms. Bleach was the only cleaning agent associated with a respiratory symptom: tightness in the chest (unadjusted OR =2.46; 95% CI: 1.01-6.89) but statistical significance did not persist after adjustment for age and sex. Hand dermatitis was associated with actual disinfecting tasks (adjusted OR =2.19; 95% CI: 1.10-4.66). Bleach was the only cleaning agent significantly associated with hand dermatitis (adjusted OR= 2.54; 95% CI: 1.32-5.13).

This study provides insight into possible work tasks that need interventions to reduce or prevent respiratory and skin symptoms in healthcare workers.

The Impact of Mental Toughness and Postural Abnormalities on Dysfunctional Breathing in Athletes.

J Asthma

While asthma and exercise-induced bronchoconstriction (EIB) can explain some cases of exertional dyspnea, the differential diagnosis of dyspnea is ...

Mast Cell-Specific MRGPRX2: a Key Modulator of Neuro-Immune Interaction in Allergic Diseases.

Current Allergy and Asthma Reports

Atopic dermatitis (AD) and allergic asthma are complex disorders with significant public health burden. This review provides an overview of the recent developments on Mas-related G protein-coupled receptor-X2 (MRGPRX2; mouse counterpart MrgprB2) as a potential candidate to target neuro-immune interaction in AD and allergic asthma.

Domestic allergens directly activate sensory neurons to release substance P (SP), which induces mast cell degranulation via MrgprB2 and drives type 2 skin inflammation in AD. MRGPRX2 expression is upregulated in human lung mast cells and serum of asthmatic patients. Both SP and hemokinin-1 (HK-1 generated from macrophages, bronchial cells, and mast cells) cause degranulation of human mast cells via MRGPRX2. MrgprB2 contributes to mast cell-nerve interaction in the pathogenesis of AD. Furthermore, asthma severity is associated with increased MRGPRX2 expression in mast cells. Thus, MRGPRX2 could serve as a novel target for modulating AD and asthma.

Unveiling the basis of antiretroviral therapy-induced osteopenia: the effects of Dolutegravir, Darunavir and Atazanavir on osteogenesis.

AIDS

Osteopenia is frequent in HIV-infected patients treated with antiretroviral therapy (ART) and has been linked to increased osteoclastogenesis. Little is known about the effects of ART on osteogenesis.

We investigated the effect on human mesenchymal stem cells (hMSC) and osteoblasts of Darunavir and Dolutegravir, the most highly used as anchor drugs within a three-drug regimen, and Atazanavir, which was widely utilized in the past.

We found that Atazanavir and Dolutegravir delay the osteogenic differentiation of hMSC, impair the activity of osteoblasts and inhibit their conversion into osteocytes, whereas Darunavir exerts no effect.

Atazanavir and Dolutegravir impair osteogenesis. It is essential to diagnose impaired osteogenesis early and to devise effective therapeutic interventions to preserve bone health in ART-treated HIV patients, putting it in the context of a correct antiretroviral combination.

High-throughput sequencing reveals a high prevalence of pretreatment HIV-1 drug resistance in Sweden.

AIDS

HIV-1 pretreatment drug resistance (PDR) is a global concern. Our aim was to evaluate high-throughput sequencing (HTS) for HIV-1 resistance testing and describe PDR in Sweden, where 75% of diagnosed individuals are foreign-born.

Individuals entering HIV-1 care in Sweden 2017 to March 2019 (n = 400) were included if a viremic sample was available (n = 220). HTS was performed using an in-house assay. Drug resistance mutations (DRMs) (based on Stanford HIV DB vs. 8.7) at levels 1-5%, 5-19% and at least 20% of the viral population were described. Results from HTS and routine Sanger sequencing were compared.

HTS was successful in 88% of patients, 92% when viral load was at least 1000 copies/ml. DRMs at any level in protease and/or reverse transcriptase were detected in 95 individuals (49%), whereas DRMs at least 20% in 35 (18%) individuals. DRMs at least 20% correlated well to findings in routine Sanger sequencing. Protease/reverse transcriptase (PR/RT) DRMs at least 20% were predicted by treatment exposure; adjusted OR 9.28 (95% CI 2.24-38.43; P = 0.002) and origin in Asia; adjusted OR 20.65 (95% CI 1.66-256.24; P = 0.02). Nonnucleoside reverse transcriptase inhibitor (NNRTI) DRMs at least 20% were common (16%) and over-represented in individuals originating from sub-Saharan Africa or Asia. Low-level integrase strand transfer inhibitor (INSTI) DRMs less than 20% were detected in 15 individuals (8%) with no association with INSTI exposure.

Our HTS can efficiently detect PDR and findings of DRMs at least 20% compare well to routine Sanger sequencing. The high prevalence of PDR was because of NNRTI DRMs and associated with migration from areas with emerging PDR.

Central nervous system disease with JC virus infection in adults with congenital HIV.

AIDS

The aim of this study was to describe the natural history of individuals with congenital HIV who develop JC virus (JCV) infection of the central nervous system (CNS).

We retrospectively evaluated individuals with congenital HIV who met criteria for progressive multifocal leukoencephalopathy (PML) or JCV granule cell neuronopathy (JCV GCN) at three major healthcare centres in the northeast USA. Data on adherence to combined antiretroviral therapy (cART), neurologic symptoms, serum markers of immunity and HIV infection, cerebrospinal fluid (CSF) analyses, radiographic features, modified Rankin Scale (mRS) scores and survival were collected from the electronic medical record up to a censoring date of 1 August 2020.

Among 10 adults with congenitally acquired HIV, nine were diagnosed with definitive PML and one was diagnosed with probable JCV GCN. Individuals presented at the time of their PML or JCV GCN diagnosis with a mean mRS of 2.0 (standard deviation 1.0). A premorbid mRS was documented for six patients and was zero in all cases. The most common risk factor was confirmed cART nonadherence in nine individuals. Five individuals with PML and one with JCV GCN died, with a latency from symptom onset to death of approximately 3 months for three individuals, and approximately 2 years for the remaining two.

Youth-adulthood transition is a high-risk point for dropping off from medical care. The study of this timepoint in people living with HIV could help inform effective care in these individuals.